Health Matters: Chronic joint pain caused by bad biomechanics


ESCANABA — The complexity of the human body is unparalleled, from top to bottom, inside and out, science has learned much about how we function, how we think, and how we move. Still, many mysteries remain. One example would be our gut biome: what do all those bacteria do and what is the interaction with our general health. One topic on which we have progressed tremendously in our understanding concerns the musculoskeletal system.

The functions of the structures composing this system should be obvious; they allow us to walk and stand, to carry things, even run and jump (at least some of us). Bones provide the framework for these functions, a stable construct upon which many structures (literally) depend. Muscles are the engines of movement, providing the power for walking, allowing you to pick up that cup of coffee. Nerves are the short term communication system while the endocrine system, utilizing hormones as its tool, is the long term.

Everyone knows what a joint is; that’s where the body bends. But do you know of the complex anatomy which allows this? Although there are others, the predominant type in humanity is one in which its covered by a capsule which contains the fluid keeping cartilage healthy. And that is the tissue allowing for smooth motion. All joints require some type of restraint to excessive movement, provided ably by our ligaments. Naturally, there are different arrangements of these important structures, with the motion allowed varying greatly. The stable, gliding mobility of a healthy joint is made possible because of the properties of joint cartilage, which provides a smooth, glassy surface more akin to a firm plastic then glass.

Whenever anyone, anywhere, at any time, refers to pain from a joint, it must be ARTHRITIS! But this is a nondescript term, meaning only that a joint is inflamed. There are many specific types of inflammatory joint conditions, over a hundred, from osteoarthritis to rheumatoid, psoriatic, degenerative, and many others. As most of us would surmise, these are common conditions, affecting roughly one in three or four Americans (depending on the study consulted).

In the disease termed osteoarthritis, there is degeneration of joint cartilage, leading to a variety of changes, from pain to bone spurs. This is obviously a common disease affecting about 32 million Americans, which works out to one in five. The joints afflicted gradually become stiffer, often with some enlargement of the site due to overgrowth of bone. Rheumatoid arthritis is a completely different type of problem. It’s one of the many autoimmune diseases in which the body attacks some component of itself, in this instance, joint structures, with particular articulations preferred.

Many are surprised to learn neither of these are the most common cause for chronic joint pain in Americans. Overuse injuries lead to symptoms more than any other single cause, but this may not be the sort you are imaging. Biomechanical causes for overuse injuries are tremendously common. In this scenario, a poorly positioned joint leads to abnormal forces experienced by some tissue. For example, if someone has an abnormally positioned knee joint, tilting ‘inward’ or ‘outward’, this will stress the structures composing the articulation, and neighboring parts as well.

The repetitive nature of gait is the key to understanding these situations. Ten thousand steps a day adds up to significant trauma if it occurs with each step, even though this abnormal motion is subtle and difficult to discern. Eventually, some structure, maybe the cartilage or ligaments, will become diseased in some fashion and produce symptoms. Many joint replacements could be prevented if skeletal alignment, from the top of the spine down to the toes, were addressed at an early age, although this is rare.

Let’s examine briefly an extremely frequent occurrence, an arch that lowers too much when walking. Generally, this is not recognized or treated, leading to physical stress to the knee joint because of the kinetic chain, a term referring to the distribution of force through the skeletal system because of our ubiquitous friend, gravity. Foot function and alignment, its biomechanics, have a tremendous effect on the amount of stress to the knee joint.

Varying terms have been applied to this disease entity, like ‘traumatic arthritis’, or degenerative joint disease, similarly degenerative arthritis. Too often, the important differences between the many arthritis diseases are not discovered and a “one blanket” approach utilized. With biomechanical issues, recognition is key. Numerous therapies, often some type of physical medicine like therapy or bracing, can prevent or reduce joint damage if instituted early.

Because the feet are the foundation of the musculoskeletal system, a functional deviation from “good and normal” can lead to symptoms, often farther up the body. Numerous treatments are obviously available for an inflamed joint, but these so often are temporary, the benefits transient, especially if they don’t address biomechanics. If you have recurrent orthopedic pain, you may have a problem with your body’s mechanical functioning. In the grand scheme of things, how our bodies move is of great importance. Here’s to walking well!

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Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula, with offices in Escanaba, Marquette, and L’Anse. McLean has lectured internationally on wound care and surgery, being board certified in surgery, orthotic therapy and wound care. His articles on health and wellness appear in multiple local and national publications. Dr. McLean welcomes subject requests for future articles at drcmclean@outlook.com.


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